Abstract WP392: Non-English Speakers Present Faster with More Severe Strokes

Introduction: With the continued expansion of acute stroke treatment options, urban tertiary referral centers such as ours are treating an increasingly diverse patient population. As we attempted to better understand barriers to improved door to treatment times in our acute stroke code protocol, we postulated that there might be differences in severity of presentation and swiftness of acute stroke care based on English fluency. Methods: Through a departmental quality improvement project to optimize local policy in the context of new acute stroke treatment guidelines, we compared National Institute of Health Stroke Scale (NIHSS) at presentation, time to presentation, and time to treatment of fluent English speakers to patients who were not fluent in English. We analyzed data from 667 acute stroke codes from January 2017 to March 2018 with Statistical Package for the Social Science (SPSS) using two-tailed t-tests. Results: In-Hospital stroke codes included 415 English speakers and 97 non-English speakers, while Outside Hospital (OSH) transfers comprised 92 English speakers and 35 non-English speakers. Non-English-speaking patients had higher average NIHSS scores at time of acute stroke presentation (11 vs 8 (p=0.013) in-hospital and 17 vs 13(p = 0.007) OSH transfer). Last known well (LKW) to stroke code time upon arrival to our center was significantly shorter in non-English speakers compared to English speakers coming from an OSH (315 minutes vs 515 minutes, p = 0.016), but there were no statistically significant differences between language groups for in-hospital codes’ LKW to stroke code times. There were no statistically significant differences in acute treatment times, but in the OSH transfer group, average LKW to groin puncture was 349 minutes for non-English speakers compared to 545 minutes for English speakers (p=0.085). Conclusions: This data suggests that at our center, non-English speakers present with more severe strokes and present more quickly. Increased stroke severity may partially explain an observed trend towards faster times from LKW to thrombectomy for non-English speakers transferred from an OSH.